NLE Musculoskeletal Nursing Reviewer 2026

Answer: B. Osteoblasts

Step 1 – Recall the two key bone cells: osteoblasts and osteoclasts. Step 2 – The prefix 'blast' means to build or form (think 'blast off' as in creating something new). Osteoblasts synthesize new bone matrix. Step 3 – In contrast, osteoclasts (prefix 'clast' = break) resorb or break down bone. Step 4 – Chondroblasts form cartilage, not bone. Fibroblasts form fibrous connective tissue. Step 5 – Therefore, osteoblasts are the correct answer for bone building.

Answer: C. Diarthrodial (synovial)

Step 1 – There are three functional joint classifications. Step 2 – Synarthrodial joints are immovable (e.g., skull sutures). Amphiarthrodial joints are slightly movable (e.g., vertebral joints). Step 3 – Diarthrodial or synovial joints are freely movable and include the knee, hip, and shoulder. Step 4 – These joints have a synovial membrane that secretes lubricating fluid and a cartilage-lined surface. Step 5 – The knee clearly allows free movement (flexion, extension), so it is diarthrodial. 'Cartilaginous' is not one of the three standard functional classifications listed.

Answer: B. Compartment syndrome

Step 1 – The question asks about the significance of pain that worsens on passive stretch. Step 2 – This is a hallmark early warning sign of compartment syndrome, caused by rising pressure within a closed muscle compartment that compromises perfusion. Step 3 – Pain out of proportion to the injury and pain on passive stretch of the digits are the EARLIEST findings — appearing before pallor, pulselessness, and paralysis (which are late signs). Step 4 – DVT causes calf tenderness and swelling but not pain on passive digit stretch. PE and fat embolism are systemic (respiratory) complications. Step 5 – Any nurse caring for a casted patient must report this finding immediately; delayed treatment can cause permanent nerve and muscle damage.

Answer: C. Absent distal pulse

Step 1 – The 5–6 Ps of neurovascular assessment progress from early to late findings. Step 2 – Pain (especially on passive stretch) is the EARLIEST sign. Paresthesia (numbness/tingling) and pallor are early-to-intermediate signs. Step 3 – Pulselessness (absent or diminished distal pulse) is a LATE and ominous sign indicating that arterial blood flow is severely compromised. Paralysis is also a late sign. Step 4 – Coolness (poikilothermia) reflects poor perfusion but is not as immediately ominous as absent pulse. Step 5 – Nurses must never wait for pulselessness before reporting deterioration — act on pain and paresthesia first.

Answer: C. Magnetic resonance imaging (MRI)

Step 1 – Each imaging modality has its strength. Step 2 – Plain X-ray is the first-line study and best shows bony detail (fractures, alignment) but poorly visualizes soft tissue. Step 3 – MRI uses magnetic fields and radio waves; it provides superior contrast of soft tissues — making it the best choice for ligaments, tendons, cartilage, herniated discs, and tumors. Step 4 – Bone scan detects areas of high bone turnover (e.g., metastasis, osteomyelitis, occult fractures). DEXA measures bone mineral density for osteoporosis diagnosis. Step 5 – NLE tip: 'X-ray = bone; MRI = soft tissue' is a high-yield memory key.

Answer: C. Support the wet cast using the palms of the hands

Step 1 – A wet plaster cast is soft and easily dented. Step 2 – Using the fingertips creates indentations (pressure points) inside the cast that press against the skin and cause pressure ulcers or nerve injury once the cast hardens. Step 3 – The correct technique is to use the flat palms to distribute pressure evenly when moving or positioning a wet cast. Step 4 – Covering a wet cast traps moisture and delays drying; plaster requires air to dry (takes 24–72 hours). A heating pad can burn the skin through the cast. Step 5 – After the cast is applied, elevate the limb above heart level for the first 24–48 hours to reduce swelling.

Answer: C. Ensure the weights hang freely without touching the floor

Step 1 – Traction works by applying a continuous pulling force to reduce and immobilize a fracture. Step 2 – For traction to be effective, the weights MUST hang freely at all times. If the weights rest on the floor or the bed, the pulling force is lost and the fracture may shift. Step 3 – The nurse must immediately correct this by ensuring the weights are free-hanging. Step 4 – Weights should NEVER be removed or added without a physician's order. Documenting and waiting is unsafe when an active problem exists. Step 5 – Proper alignment and countertraction (patient's body weight) must also be maintained to ensure traction effectiveness.

Answer: C. The hands (handgrips)

Step 1 – Crutches are fitted so there is a 2–3 finger-width gap (about 5 cm) between the axillary pad and the armpit. Step 2 – Weight must be borne on the HANDS via the handgrips, not on the axillae. Step 3 – Leaning body weight on the axillary bar compresses the brachial nerve plexus in the armpit, causing a condition called 'crutch palsy' — characterized by weakness or paralysis of the arm and hand. Step 4 – Patients must be clearly taught to keep the axillary pads only lightly touching the chest wall for balance, while pushing down on the handgrips. Step 5 – This is a high-yield patient safety teaching point for the NLE.

Answer: B. On the left (unaffected/stronger) side

Step 1 – The purpose of a cane is to shift some body weight away from the weak or painful limb. Step 2 – The cane is held on the STRONG (unaffected) side. When the weak leg steps forward, the cane on the opposite side moves forward simultaneously, creating a wider base of support and reducing load on the injured limb. Step 3 – This mirrors the normal arm-swing pattern: the arm on the opposite side naturally swings forward with each step. Step 4 – Holding the cane on the affected side actually increases the load on the injured hip, which is incorrect. Step 5 – Always assess the patient's gait after teaching to confirm correct technique.

Answer: B. Encourage increased fluid intake after tracer injection to help excrete it

Step 1 – In a bone scan, a radioactive tracer (technetium-99m) is injected intravenously and takes 2–3 hours to distribute in the bone before scanning begins. Step 2 – After injection, the nurse should ENCOURAGE oral fluid intake to distribute the tracer and to help the kidneys excrete unused tracer through urine. Step 3 – Restricting fluids would slow excretion and unnecessarily prolong radiation exposure. Step 4 – Removing metal implants before the procedure is required for MRI, NOT bone scan. NPO is not required for a bone scan. Step 5 – Reassure the patient that the radioactive dose is very small and poses minimal risk.

Answer: B. Open (compound) fracture

Step 1: Recall the defining feature – the bone breaks through the skin, creating an external wound. Step 2: An open (compound) fracture is defined by bone that has broken through the intact skin surface, exposing the bone to the environment. Step 3: This creates a HIGH risk of infection and osteomyelitis, making it a more serious injury than a closed fracture. Step 4: A closed (simple) fracture keeps the skin intact. A greenstick fracture is an incomplete bend-and-crack fracture seen in children. An impacted fracture means one fragment is driven into another. Step 5: On the NLE, 'open' and 'compound' are used interchangeably – both mean skin is broken.

Answer: C. Greenstick fracture

Step 1: Recall that children's bones have more flexibility (pliability) than adult bones because they are still developing. Step 2: A greenstick fracture is an incomplete fracture where the bone bends and cracks on one side but does not break all the way through – similar to how a green, fresh tree branch bends without fully snapping. Step 3: This is the classic pediatric fracture type tested in the NLE. Step 4: A comminuted fracture involves bone splintered into multiple pieces. A spiral fracture has a twisting fracture line and may suggest abuse when history doesn't match. A transverse fracture has a straight fracture line across the bone. Step 5: The key word in the question is 'pliable bones' – this points directly to greenstick.